Starshine Registration Form
Please fill out this form for EACH family of Starshine participants.
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Participant name (first, last) *
Participant preferred pronouns *
Participant age *
Parent/Guardian name (first, last) *
Parent/Guardian preferred pronouns *
Parent/Guardian email *
Parent/Guardian phone *
Emergency contact name *
Emergency contact phone *
Please list any medical, social, emotional, or learning conditions of the participant that are relevant for the instructor to know in order to keep the participant safe, as well as, design an appropriate program suited to their needs? *
How did you find out about Starshine?
Would you like to sign up for email updates from to learn about future Starshine opportunities?
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